What question did this study set out to answer?

This analysis aims to determine if the effectiveness of finerenone and empagliflozin varies based on baseline HbA1c levels.

June 17, 2026

Impact of Simultaneous Initiation of Finerenone and Empagliflozin on Albuminuria Irrespective of Baseline HbA1c Levels: A Participant‐Level Exploratory Analysis of the Randomised CONFIDENCE Trial

Key Points

This analysis aims to determine if the effectiveness of finerenone and empagliflozin varies based on baseline HbA1c levels.
Adults with type 2 diabetes and specific UACR and eGFR levels were randomized (1:1:1) to receive finerenone, empagliflozin, or both.
The primary outcome measured was the change in UACR from baseline at Day 180.
Combination therapy significantly reduced UACR more than monotherapy across all HbA1c quartiles (% change in Quartiles 1-4: −53%, −47%, −63%, −55%).
HbA1c levels decreased with combination therapy and empagliflozin, while there was no change with finerenone.

Abstract

ABSTRACT Aims This prespecified analysis evaluated whether the safety and efficacy of finerenone and a sodium–glucose cotransporter 2 inhibitor (SGLT2i) combination vary by baseline glycated haemoglobin (HbA1c). Materials and Methods Adults with type 2 diabetes and a urinary albumin‐to‐creatinine ratio (UACR) of 100 − 6.4 and ≤ 7.1% > 46 and ≤ 54 mmol/mol), 3 (HbA1c > 7.1 and ≤ 7.9% > 54 and ≤ 63 mmol/mol) and 4 (HbA1c > 7.9% > 63 mmol/mol), respectively. Change from baseline in HbA1c at Day 180 was greatest in Quartile 4. At Day 180, combination therapy reduced UACR from baseline in all HbA1c quartiles to a greater extent than either monotherapy (mean 95% CI –53% −63, −42, −47% −57, −34, −63% −70, −54 and −55% −65, −42, in Quartiles 1–4, respectively). Conclusion Simultaneous initiation with finerenone and an SGLT2i reduced UACR compared with monotherapy and was well‐tolerated irrespective of HbA1c levels.

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